Of all the things you’d think might happen in an operating room (OR), a patient catching on fire is probably near the bottom of the list. Yet around 600 times a year in the United States that’s exactly what happens. The medical community calls these occurrences surgical fires.
There are principally two regulatory bodies that have significant influence on OR safety when it comes to surgical fires.
The FDA role in surgical fire safety
First, the U.S. Food and Drug Administration (FDA) regulates many medical devices, products, and supplies used in an OR. Regulated items include things such as medical gases, alcohol-based agents that are used to prepare the skin for surgery, electrosurgical devices, surgical drapes, and lasers.
When there’s a surgical fire involving a regulated product, it must be reported to the FDA. This allows the FDA to determine whether a surgical fire is an isolated incident or related to a product defect that may require some remedial administrative action.
Accreditation standards improve surgical fire safety
Second, accredited hospitals and surgery centers are expected to comply with standards and guidelines put out by accrediting bodies, such as The Joint Commission.
Facility accreditation standards work in two ways. First, they aim to prevent bad things from happening in the healthcare setting. Second, they require hospital and facility leaders to investigate when sentinel events occur, to make sure they don’t happen again. Sentinel events are things that should never happen under the standard of care. The Joint Commission requires every sentinel event to be the subject of a root cause analysis, with the idea being that we should learn from our mistakes.
How do surgical fires happen?
I like the way one FDA engineer answered this question. Surgical fires can occur when all three elements of the fire triangle are present in an OR:
• An ignition source. This is a heat source, such as an electrosurgical unit or laser, that can start a fire.
• A fuel source. Every fire needs a fuel and in the operating room it could be a surgical drape or alcohol-based products that are placed on the patient’s skin. Even worse, the patient’s own body, including tissue, hair, skin, or even eyeballs, can be a fuel source.
• An oxidizing source. Any fireman would tell you that oxygen feeds fires. In operating rooms, patients are often given supplemental oxygen or other medical gases that can act as an oxidizer for fire.
The challenge in surgical fire prevention is that all three elements of the fire triangle are typically present for any given surgery.
Root cause studies of surgical fires have shown that OR doctors and staff need to think ahead and avoid placing an ignition or heat source too close to oxygen. High concentrations of oxygen in the operating room are typically the culprit in surgical fires.
Many years ago, The Joint Commission developed a surgical error prevention tool called the universal protocol. The universal protocol is now the standard of care and requires all OR personnel to take a surgical timeout before proceeding with an operation. The focus includes making sure that they have the right patient for the right procedure and the right site. Medical experts now recommend adding fire risk assessment to the universal protocol and to re-assess the risk throughout the surgery.
In addition to thinking about surgical fire risk ahead of time, the FDA recommends:
• OR personnel should think carefully think about whether the patient really needs extra oxygen.
• Nurses should be careful with alcohol-based products that are used on the skin, preventing the liquid from pooling and making sure the skin is completely dry before proceeding with draping the patient.
• Don’t place potential ignition sources on the surgical drapes. Instead, when they are in use, holster them away from the patient.
• Make sure the entire OR team is communicating well before and during surgery.
Surgical fire medical malpractice
In the hundreds of surgical fires that occur every year in America, some patients are left with minor injuries, while others suffer serious injuries and disfigurement from second- and third-degree burns, or even die (particularly when a surgical fire starts in the patient’s airway). Sadly, these surgical fires can almost always be prevented with proper medical and nursing care.
Various healthcare providers may be at fault in a surgical fire.
The surgeon controls and uses the surgical equipment that’s the ignition or heat source.
Operating room nurses are in charge of the fuel sources, including surgical drapes and alcohol-based skin preparation.
The anesthesiologist or certified registered nurse anesthetist (CRNA) is in charge of the medical gases and oxygen, which are the oxidizer sources for surgical fires. Sometimes the anesthesia provider follows the surgeon’s preference or request on how to administer oxygen, and that, too, can be a factor.
While there’s no doubt that some surgical fires are caused by equipment failure, in my experience the majority of them are not. Most surgical fires are caused by healthcare providers that are in a hurry, not paying attention, and not talking and coordinating with each other. In those situations, patient safety comes second.
If you’ve been seriously injured because of a surgical fire, then contact a top-rated experienced Houston, Texas medical malpractice lawyer for help in investigating your potential case.